A. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless paramedics or other emergency staff is given other instructions, they will try to resuscitate any patient whose heart has stopped or who has stopped breathing.

FACT: The exact rules for obtaining a DNR and for proving its validity vary widely from state to state.

Once you complete a DNR, make sure your physician and others are aware of your wishes. Give a copy of your DNR to your primary physician and request that this information is added to your medical records. If you are in a hospital, make sure a copy of your DNR is included with your medical chart. Keep a copy of the original DNR form in your estate planning files.

FACT: Generally, doctors and hospitals in all states respect DNR orders.

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Q. Why do you need to complete a living will and a DNR?

A. The directions in your living will are only followed when your doctor believes you are in a terminal state and will not recover from your illness or injury. The directions in your DNR are effective the moment you sign them and do not require any type of medical condition to be present for the DNR to be effective.

Elderly people sometimes want a DNR if they suffer from chronic illnesses and are concerned that their quality of life will suffer if they require resuscitation.

Q. What happens if the paramedics do not know you have completed a DNR?

A. If the paramedics or other medical personnel cannot locate your DNR, they will make an effort to save your life.

You can help the paramedics make the right treatment choices in several ways:

· Participate in the Vial of Life program. The Vial of Life program is a nationwide effort to assist emergency personnel administer proper medical treatment for you when you can’t speak for yourself. A Vial of Life sticker is placed on your door. This sticker tells the paramedic to look for your DNR and other medical information in a vial placed in your refrigerator. Some people recommend storing the DNR in the freezer in a blue freezer bag, as paramedics are trained to look there for DNR documents.

· Some states authorize the use of identification bracelets or tags as a way for you to notify medical personnel that you have signed a DNR. Although all states authorize the use of a DNR, some states require special paper be used when printing as a means of authentication.

A FAMILY STORY: No DNR Present.

Kathy’s 92-year old mother was at Kathy’s house watching TV when she suddenly said she could not breathe. Kathy called an ambulance.

As they prepared to take her mother to the hospital, Kathy explained to the paramedic that she and her mother had decided not to resuscitate if the situation was such that her quality of life could be impaired.

The paramedic asked to see the DNR form. Kathy replied the form was at her mother’s house in another state. Kathy could not provide a copy of the DNR signed by her mother to the paramedic.

The paramedic said they were allowed to wait sixty seconds for someone to provide the DNR. After that, they are required by law to administer all available life saving techniques.

Kathy now keeps a copy of the DNR in her freezer and in her purse. Her mother wears a DNR bracelet.

Q. How do you complete a DNR?

A. Your physician must complete and sign a DNR on your behalf. In some states, you must wear a DNR bracelet showing you have a DNR on file. The DNR state rules identify the name of the form required in your state and other facts you need to create an effective DNR.

Like all legal documents, you need to complete a DNR before you have a heart attack or other medical condition that would appear to compromise your mental abilities. Once your mental capacity has been substantially compromised, it is possible for a physician to determine that you lack sufficient mental capacity to provide informed medical consent.

If the physician considers your mental capacity is diminished, it will be too late for you to instruct the medical staff not to resuscitate you. These orders must be made when you are healthy.